目的 观察辅助性T17细胞（Th17）与调节性T细胞（Treg）比值与2型糖尿病（T2DM）患者胰岛素抵抗及胰岛β细胞功能的关系。方法 纳入2022年4月—2023年4月在贵州医科大学第二附属医院内分泌科住院及健康体检人群各100例, 分为糖耐量正常组（NGT组, n=100）和T2DM组（n=100）, 分别测定糖化血红蛋白（HbA1c）、空腹血糖（FPG）、甘油三酯（TG）等生化指标, 电化学发光法测定空腹胰岛素（FINS）, 稳态模型计算胰岛β细胞功能指数（HOMA-β）、胰岛素抵抗指数（HOMA-IR）及胰岛素敏感指数（HOMA-ISI）。流式细胞术检测Th17、Treg水平。HOMA-IR、HOMA-β和HOMA-ISI的影响因素采用多元线性回归分析。结果 与NGT组相比, T2DM组BMI、FPG、HbA1c、LDL-C 、TG、TC、FINS、HOMA-IR、Th17及Th17/Treg水平均升高（P<0.01）, HDL-C、HOMA-β、HOMA-ISI、Treg水平均降低, 且差异有统计学意义（P<0.01）。Th17与BMI（r=0.251, P<0.001）及HOMA-IR（r=0.305, P<0.001）呈正相关; 与HOMA-β（r=-0.204, P<0.001）及HOMA-ISI（r=-0.359, P<0.001）呈负相关。Treg与HOMA-ISI之间呈正相关（r=0.170, P=0.008）, 而与HOMA-IR呈负相关（r=-0.153, P=0.017）; Th17/Treg与BMI（r=0.332, P<0.001）及HOMA-IR（r=0.374, P<0.001）;与HOMA-β（r=-0.249, P<0.001）及HOMA-ISI（r=-0.427, P<0.001）呈负相关。多元线性回归分析显示, Th17/Treg是HOMA-IR（β=5.915）升高及HOMA-ISI（β=-2.557）下降的影响因素（P<0.01）。结论 Th17/Treg可能通过影响胰岛素抵抗、降低胰岛素敏感性参与T2DM的发生。

Objective To explore the relationship among the proportion of helper T17 cells（Th17）to regulatory T cells（Treg）, insulin resistance, and the function of islet beta cells．Methods One hundred cases of hospitalized patients and 100 cases of health check-ups people in the Department of Endocrinology of the Second Affiliated Hospital of Guizhou Medical University from April 2022 to April 2023 were included．Patients were divided into normal glucose tolerance group（NGT group, n=100）and type 2 diabetes mellitus group（T2DM group, n=100）．The biochemical indexes of HbA1c, fasting blood glucose（FPG）, triglyceride（TG）and fasting insulin（FINS）were determined by electrochemiluminescence．Islet beta cell function index（HOMA-β）, insulin resistance index（HOMA-IR）and insulin sensitivity index（HOMA-ISI）were calculated in homeostasis model．The levels of Th17 and Treg were detected by flow cytometry．Spearman was used to analyze the correlation between indicators, and multiple linear regression analysis was used to analyze the influencing factors of HOMA-IR, HOMA-β and HOMA-ISI．Results In contrast to the NGT group, the T2DM group exhibited elevated levels of BMI, FPG, HbA1c, LDL-C, TG, TC, FINS, HOMA-IR, Th17 and Th17/Treg, with these variances being signifincantly different（P<0.01）．There was a notable reduction in the levels of HDL-C,HOMA-β,HOMA-ISI,Treg,with those changes being significantly different（P<0.01）．Th17 was positively correlated with BMI（r=0.251, P<0.001）and HOMA-IR（r=0.305, P<0.001）, it was negatively correlated with HOMA-β（r=-0.204, P<0.001）and HOMA-ISI（r=-0.359, P<0.001）．Treg was positively correlated with HOMA-ISI（r=0.170, P=0.008）, while it was negatively correlated with HOMA-IR（r=-0.153, P=0.017）．The ratio of Th17/Treg was positively correlated with BMI（r=0.332, P<0.001）and HOMA-IR（r=0.374, P<0.001）, it was negatively correlated with HOMA-β（r=-0.249, P<0.001）and HOMA-ISI（r=-0.427, P<0.001）．Multiple linear regression analysis showed that Th17/Treg was an influential factor in the increase of HOMA-IR（β=5.915）and the decrease of HOMA-ISI（β=-2.557）（P<0.01）．Conclusions Th17/Treg may be involved in the development of T2DM by affecting insulin resistance and reducing insulin sensitivity．

目的 分析多囊卵巢综合征患者性激素水平与胰岛素抵抗关系。方法 此次研究所设置的观察组对象为我院收入的多囊卵巢综合征患者,均在2017年5月—2020年7月入院,入选患者共100例。选取同一时期到我院进行相关检查的健康育龄女性100例作为对照组。分别检测、统计2组女性的性激素[包括性激素黄体生成素(LH)、睾酮(T)、雌二醇(E2)、卵泡刺激素(FSH)]、空腹血糖(FBG)、空腹胰岛素(FINS)以及胰岛素抵抗指数,对性激素水平与胰岛素抵抗关系进行分析。结果 相比于对照组,观察组女性的LH、T水平更高(P＜0.05),E2、FSH水平更低(P＜0.05),且FBG、FINS、胰岛素抵抗指数均更高(P＜0.05)。观察组中,胰岛素抵抗与非胰岛素抵抗患者的性激素水平与胰岛素抵抗指数,胰岛素抵抗女性与非胰岛素抵抗女性的LH、TE2、FSH水平均具有差异(P＜0.05)。LH、E2、FSH水平与胰岛素抵抗指数无相关性(P＞0.05),T水平与胰岛素抵抗指数呈正相关(P＜0.05)。结论 多囊卵巢综合征患者的性激素出现了一定的分泌紊乱现象,其中T水平与胰岛素抵抗具有相关性。

Objective To analyze the relationship between sex hormone levels and insulin resistance in patients with polycystic ovary syndrome. Methods The subjects of the observation group set up in this study were patients with polycystic ovary syndrome admitted to our hospital, all of whom were admitted from May 2017 to July 2020, and a total of 100 patients were enrolled.One hundred healthy women of childbearing age who came to our hospital for relevant examinations during the same period were selected as the control group.Sex hormone [including luteinizing hormone (LH), testosteron (T), estradiol (E2), follicle stimulating hormone (FSH)] levels, fasting blood glucose (FBG) level, fasting insulin (FINS) level, and insulin resistance index were detected and summerized in the two groups of women separately, and the relationship between sex hormone levels and insulin resistance was analyzed. Results Compared with the control group, women in the observation group had higher LH and T levels (P<0.05), lower E2 and FSH levels (P<0.05), and higher FBG, FINS levels, and insulin resistance index (P<0.05). In the observation group, sex hormone levels and insulin resistance index in insulin-resistant and non-insulin-resistant patients, and LH, TE2, and FSH levels in insulin-resistant and non-insulin-resistant women were different (P<0.05). There was no correlation between LH, E2, and FSH levels and insulin resistance index (P> 0.05), and T level were positively correlated with insulin resistance index (P<0.05). Conclusion Patients with polycystic ovary syndrome showed some disturbance in the secretion of sex hormones, among which T level were correlated with insulin resistance.

目的 探讨胰岛素抵抗对缓解期双相障碍患者转归和社会功能的影响。方法 对双相I型患者90例以及正常对照组30例进行体质量指数、空腹血糖、胰岛素等测定,计算胰岛素抵抗指数;长期治疗应答回顾标准量表评估治疗应答、大体社会功评估量表评估社会功能,分析胰岛素抵抗对双相患者转归和社会功能的影响。结果 患有2型糖尿病或胰岛素抵抗的双相障碍患者治疗应答反应差(2.50和2.93 vs 4.77,F=5.636,P<0.01;OR=6.07和4.78,P<0.01),双相发作次数多(0和0.03 vs 0.33,F=59.475,P<0.01),社会功能更差(GAF:56.90和53.23 vs 73.93,F=6.010,P<0.05;OR=1.59和4.82,P<0.01)。治疗应答、社会功能与胰岛素抵抗指数呈负相关(r=-0.383和-0.307,P<0.01)。社会功能与治疗反应、非典型抗精神病药物和药物副反应相关(r=0.467, -0.314,-0.407,P<0.05或P<0.01)。结论 共病糖尿病或胰岛素抵抗可能是双相障碍治疗抵抗、社会功能损害的一个重要的因素。

Objective To investigate the effect of insulin resistance on outcome and social function in patients with bipolar disorder at remission stage. Methods The body mass index(BMI),the levels of fasting plasma glucose,insulin and glyeosylated hemoglobin were detected in 90 BD patients without diabetes(BD group)and 30 normal controls (NC group). Alda scale was used to assess treatment response, and Global Assessment of Functioning Scale was used to assess social function. The effect of insulin resistance on outcome and social function was analyzed. Results Patients with bipolar disorder with type 2 diabetes or insulin resistance have poor response to treatment(2.50,2.93 vs 4.77,F=5.636,P<0.01;OR=6.07& 4.78,P<0.01), more recurrences (0,0.03 vs 0.33,F=59.475,P<0.01;OR=1.59&4.82,P<0.01), and worse social function (GAF:56.90,53.23 vs 73.93,F=6.010,P<0.05). Treatment response and social function were negatively correlated with insulin resistance index (r=-0.383,-0.307,P<0.01), and social function was associated with treatment response, atypical antipsychotics, and side effects (r=0.467, -0.314,-0.407,P<0.05 or P<0.01). Conclusion Diabetes mellitus or insulin resistance may be important factor in therapeutic resistance and social function to patients with bipolar disorder.

目的 探讨血糖控制情况对胰岛素抵抗型糖尿病合并肺结核的临床治疗转归的影响。方法 选取我站收治的胰岛素抵抗型糖尿病合并肺结核的患者180例,随机分成对照组和观察组两组,每组各90例,对照组给予常规监测晨起空腹血糖和餐后2 h血糖,观察组给予监测血糖谱(包括三餐前、三餐后2 h、凌晨3点和晨起空腹血糖);观察组与对照组中患者均利用2HRSZ(E)／10HR(E)方案来进行治疗;记录两组患者治疗前后空腹血糖、餐后2 h血糖、痰菌阴转情况、X线胸片病灶情况和空洞变化情况,对比分析两组的临床治疗效果。结果 观察组的痰菌阴转、X线胸片病灶、空洞变化等均比对照组的效果好,且两组差异有统计学意义(P＜0.05);观察组的总体有效率87.8%(79/90)高于对照组的71.1%(64/90),两组差异有统计学意义(χ²=7.655,P=0.006)。结论 控制血糖能有效提高胰岛素抵抗型糖尿病合并肺结核的临床治疗效果,在临床上值得推广应用。